People who develop metabolic syndrome after starting HIV treatment have an increased risk of diabetes and heart disease, according to a study published in the November 30 issue of AIDS. Metabolic syndrome includes unhealthy changes in cholesterol, blood sugar and fat accumulation in the waist, and may increase a person’s risk for developing adult onset diabetes and heart disease. Although studies have not found that metabolic syndrome is more common in people with HIV than people who are HIV negative, HIV treatment can cause it.

Sean Emery, PhD, of the National Centre in HIV Epidemiology and Clinical Research at the University of New South Wales in Sydney, Australia, and his colleagues conducted regular measurements of body mass index, hip and waist circumference, and cholesterol and blood sugar in 881 people starting HIV treatment for the first time. They sought to determine whether development of metabolic syndrome after starting HIV treatment would also increase a person’s risk for developing diabetes and/or heart disease. People in the study were randomized to receive Videx (didanosine) plus Zerit (stavudine) and either Sustiva (efavirenz), Viracept (nelfinavir) or Sustiva and Viracept.

Roughly 8 percent of the study participants had metabolic syndrome before starting treatment. Approximately 200 people developed metabolic syndrome after starting treatment, and this increased a person’s risk of developing heart disease by more than 300 percent and diabetes by as much as 434 percent compared with people who did not develop metabolic syndrome. Increases in triglycerides combined with increases in blood sugar and blood pressure were the factors most commonly associated with an increased risk for heart disease. None of the treatment combinations were more likely than the others to lead to the development of metabolic syndrome.

The authors note that overall, the percentage of people with metabolic syndrome in the study is lower than that found in the general population or in other studies of people with HIV, and that this could be because people in this study were generally younger than in other studies and more likely to be female. They also state, however, that this is the first study to assess the development of metabolic syndrome in people starting HIV treatment and its impact on risk for diabetes and heart disease, and that the results suggest that metabolic syndrome should be considered as an important risk factor for both conditions.